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Deciaration of Domic~le and Citizensh~p
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE CpU~y~ FLORIDA: ~M~~~~
This ia my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in
accordance. and in conformity with Section ~2~.I7, Ftorida Statui~. -
_ , 1/ Q' , and I
I wss formerly a legai r~sident of ~ ~~a~
~ . How~ever, I have ch~n nty domicile to
resided at fn G 1V ~v s~ r 6~
• (su«t aed flu~neer)
and am and have been a bona fide resident of the State of Ftorida since 9~ ~ day of
~
, 19-~, and I reside at ~ ~ L
' Nwaber)
~ E ~ ~ C / ,Q _ S t . Luc e County, Florida, .
tci~r)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.• - ~
pe~t ~ae aay Pec~ioertt isc~s. such as sate ot prop«tr or busiaas. o~ nNnQuisha~snt ot empbrmeot at tormrr
domicW~ rs~povsl of fantilr to aew doa~icile. Pwcl?ae ot home. etc.) •
~ • HOMESTEAD EXEMPTION: ~
ENTERING CHILDREN IN SCHOOL. ,
If entering children in school,
please list~their n~ames:
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Cf . ,~.u ~t- -
~ , . - -
~ ~0.~8 ~t?~8
s~ us~~~ c~~~i,
. ~iE~ci~C~
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RECOiiD VEP.~-1E0 - ~
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~ 296540 ~
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I FURTNER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all other requirements of a legai resident af this State. ~
I FURTH ER FY at I have no intention to return to my former domicile, and I intend to remain in
' ST. LUCIE
(~j f L Gl e , County,
Fiorida, permanently. ca~r) _ .
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`ii!„' _.~~~.4 . 4i: -
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~5~~,: S IGNATLIRE
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-~~~d s~,i~sert't~f~c me this day of ~ ~
r . ~ ~ _ L ~
' f ~ ~iP ~ 4
~ ~ 74 ~O/ ~ G O ~ 9~/
A.D. 19
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K~ ~~8 ~ CLE~ K CIRCUIT COURT f~u~~~~ , Florida
. . _
g ~ Deputy Clerk -
y . .
~ (To be eceted in duplicste and oti~inal ftled with C{etk Cittuit Court. and dyplicate with Tst Asseasot) .
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